Annual Facility Survey (CMS-2744)


The ESRD Annual Facility Survey (CMS-2744) is an annual report that dialysis facilities must turn in to their Network. The survey is designed to capture only a limited amount of information concerning each federally-approved renal facility’s operation. It is not intended to yield information on the full range of ancillary services or activities, e.g., referrals, graft outcome, etc.

Every facility/center approved by Medicare to provide services to ESRD patients must furnish the information requested in the ESRD Facility Survey (42 U.S.C. 426; 20 CFR 405, Section 2133). It is also the facility’s/center’s responsibility to provide patient and treatment counts to their local ESRD Network upon termination of operations. Facilities certified as only providing inpatient services are not requested to complete a survey.

The CMS-2744 lists:

  • Patients receiving care at the beginning of the reporting period
  • Patients added to the facility during the reporting period
  • Patient losses at the facility during the reporting period
  • Number of patients present at the facility at the end of the reporting period
  • Patients Medicare enrollment status
  • Hemodialysis patients dialyzing more than four times per week
  • Vocational rehabilitation status of patients
  • Number of Hemodialysis and Other treatments in center
  • Staffing
You cannot delete the CMS-2744 form once you create it. Once submitted, the ESRD Network will review the CMS-2744 and accept it or reject it. The instructions for each field of the CMS-2744 can be obtained here (ESRD Facility Survey Instructions for Completion).

Forms and Instructions 


Page last updated: 9/9/2014